A significant proportion of older people in the United Kingdom (UK) die in hospital, with variable quality of care. A palliative approach, which involves recognising and alleviating suffering, might lead to improved quality of care. Yet suffering is an intangible and contested phenomenon and little is known about people’s actual experiences of suffering in this clinical setting. Further, it has been argued that an acute hospital setting is not well equipped to support dying well.

Aim To examine the context of end-of-life care for older people in an acute hospital setting, particularly focusing on the experience of suffering.

Design An observational study was conducted guided by the principles of sensory ethnography, within an interpretivist framework. Data analysis was inductive and iterative. Reflexive analysis included observations and inferences from a participant-observer perspective. Over a period of three months in 2016, 186 hours of observations were carried out.

Settings/Participants The study was carried out on a 30-bedded acute older peoples’ hospital ward in the UK. Participants included 11 patients and 33 members of staff and visitors.

Results Patient suffering was influenced by a range of factors. Delays in recognising and acknowledging dying often led to treatments that were burdensome or futile, exacerbating patient suffering. Environmental factors in the physical clinical setting also exacerbated suffering. Finally, aspects of interpersonal interactions were observed to adversely affect patient experience.

Conclusion Acute care for older people in hospital was shaped by an overarching ideology of rescue which predicted and dictated the process of care. Findings demonstrated that suffering was not restricted to the direct experiences of life-limiting illness but was also associated with the experience of receiving care in an acute hospital setting. Avoiding or minimising iatrogenic suffering is an essential component of compassionate care.